Healthcare Provider Details

I. General information

NPI: 1124094883
Provider Name (Legal Business Name): EDWARD C MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PKWY STE 120
CHESAPEAKE VA
23320-4985
US

IV. Provider business mailing address

300 MEDICAL PKWY STE 120
CHESAPEAKE VA
23320-4985
US

V. Phone/Fax

Practice location:
  • Phone: 757-252-5660
  • Fax: 757-548-9443
Mailing address:
  • Phone: 757-252-5660
  • Fax: 757-548-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101032556
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101032556
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101032556
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: